Are German family practitioners and psychiatrists sufficiently trained to diagnose and treat patients with alcohol problems?

BACKGROUND: Harmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol consumption, and about 1.8 million adults in Germany (18-64 years) are classified as alcohol dependent. A treatment rate of 9% of all alcohol dependent patients in Germany implies a lack of supply and misuse of medical care. The aim of the study was to examine whether family practitioners (FPs) and psychiatrists have sufficient skills to diagnose and treat patients with alcohol problems. METHODS: A total of 6324 FPs and psychiatrists in the states of Saxony and Rhineland-Palatinate in Germany were invited to participate in this survey. Nine hundred seventy-four participants (90.3%/FPs) could be included in the statistical analysis (response rate: 14.3%/FPs, 21.6%/psychiatrists). Data was analysed descriptively and logistical regressions were used to identify predictors for physicians' ability to feel adequately trained to diagnose and treat patients with alcohol problems. RESULTS: In comparison to psychiatrists, less FPs reported feeling sufficiently trained to counsel patients with alcohol problems (81.5% vs. 44.8%). Regression analysis revealed that FPs who felt not adequately trained had less experience with patients with alcohol dependence (OR 7.4), had attended fewer hours on alcohol addiction in continuing medical education (OR 4.8), and were more likely to be female (OR 1.9). A minimum of 10 h of training was associated with improved self-assessed competence. CONCLUSION: Harmful drinking is a serious public health problem, and patients with alcohol dependence represent a large and demanding patient group in primary health care setting. Our study shows that the lack of training is a severe barrier in the work with this patient group in the primary care setting.

[Preferred Medical Specialties of Medical Students in Contrast to the Need for General Practitioners in Saxony]. / Facharztpräferenzen von Medizinstudierenden im Kontrast zum Bedarf an Allgemeinmedizinern in Sachsen.

Aim of the study: Especially in the rural areas of Germany, there are not enough general practitioners (GPs) for primary care. Preferred medical specialties of medical students can help get an estimate of the number of future GPs. This study compares this estimate to the current need for GPs in Saxony. Methods: 587 medical students at the second, sixth and tenth semester were invited to take part in an anonymous cross-sectional study regarding their specialty preferences at the Technical University Dresden. Based on the data of the medical requirements for Saxony, 4 model calculations were generated for comparison of the estimated numbers of future GPs and the current need for GPs. Results: The most commonly preferred medical specialties were surgery (19.1%), internal medicine (12.9%), pediatrics (11.6%) and general practice (9.9%). A significant increase in specialist preference for GP was observed from the sixth (4.9%) to the tenth semester (14.0%). The model calculations show that approximately 29% to 111% of the open positions for GPs could be filled by the potential new GPs from Dresden. Conclusion: Currently, medical students planning to become GPs cannot meet the corresponding need for GPs. Future studies should include the points of view of students, continuing education assistants, GPs and patients.

Factors influencing sleep quality among nursing staff: Results of a cross sectional study.

PURPOSE: Given the intense physical and mental demands placed on nurses and other caregivers, getting sufficient sleep is essential to maintaining both individual health and professional performance. The goal of our study is to describe and analyze the self-reported sleep quality of nursing staff and identify which factors have an influence on it. METHODS: The sample was comprised of 153 female nurses over the age of 20 years who completed written surveys regarding their health status and health behavior. Their responses were subjected to ANOVA analysis with post hoc follow-up tests and logit regression was used. RESULTS: 33% of female nursing staff reported poor quality sleep. Lower quality of life, tachycardia and unequal distribution of work load were most strongly associated with poor sleep quality. CONCLUSION: Our study indicates that reducing workplace stress is a good place to start in developing a proactive strategy. A comprehensive prevention strategy should include both behavioral and situational prevention elements. Future studies should focus on identifying causal factors and developing prevention strategies.

Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project.

Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes. Although national programs exist, there is no EU-wide strategy for diabetes self-management education, and patients with limited literacy face barriers to effective self-management. The Diabetes Literacy project, initiated with the support of the European Commission, aims to fill this gap. The project investigates the effectiveness of diabetes self-management education, targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States, as part of a comprehensive EU-wide diabetes strategy. National diabetes strategies in the EU, US, Taiwan, and Israel are compared, and diabetes self-management programs inventorized. The costs of the diabetes care pathway are assessed on a per person basis at national level. A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support, and the moderating role of health literacy, organization of the health services, and implementation fidelity of education programs are considered. Web-based materials are developed and evaluated by randomized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy. The 3-year project started in December 2012. Several literature reviews have been produced and protocol development and research design are in the final stages. Primary and secondary data collection and analysis take place in 2014. The results will inform policy decisions on improving the prevention, treatment, and care for persons with diabetes across literacy levels.

[Sexual risk behaviour of nursing students. A cross-sectional study at nursing schools in Saxony-Anhalt]. / Das sexuelle Risikoverhalten von Auszubildenden der Gesundheits- und Krankenpflege. Eine Querschnittstudie an Krankenpflegeschulen in Sachsen-Anhalt.

AIM: This work describes the sexual risk behaviour of nursing students. METHODS: 22 of 23 state-approved nursing schools in Saxony-Anhalt, Germany, participated in this cross-sectional study (study period 7/2005-5/2006). Participation was voluntarily and anonymous. RESULTS: More male than female students (59.6% vs. 44.8%) used condoms to prevent STIs. More female students (58.9% vs. 43.4%) reported constant partnership with just one partner as an STI prevention method (chi² test, p<0.005). 29.6% of the nursing students reported >1 sexual partner in the past 12 months. 3.9% of the students demanded an HIV test from the partner, 69.3% had never tested themselves for HIV. 10.2% used no prevention against STIs. CONCLUSIONS: Nursing students should be sensitised for sexual risk behaviour and STIs. This should be included in the content of teaching throughout the education, not least since nursing students are multiplicators and have an influence on health behaviour of the patients.

Medical students' knowledge and attitudes regarding vaccination against measles, influenza and HPV. An international multicenter study.

INTRODUCTION: Inaccurate information leads to increased scepticism concerning vaccinations among health care workers. Therefore, a proper education of medical students on vaccination is important. METHODS: During summer term 2015, we performed a paper-based survey to identify the knowledge and attitudes of medical students on vaccinations against measles, influenza and HPV in seven medical schools in Germany, Austria and Switzerland. RESULTS: Altogether, 3,652 questionnaires were analyzed. Knowledge of country-specific public recommendations increased significantly with the number of semesters of medical studies. Concerning the knowledge about vaccinations against measles, influenza and HPV, one third of the answers were given correctly. Again, a strong correlation between the knowledge and the semester of medical studies could be observed. The attitudes concerning vaccinations in general and especially for HCWs were highly positive. CONCLUSIONS: This study provides some important arguments for the development of a comprehensive vaccination education for medical students.

Radical prostatectomy: OSU and affiliated hospitals' experience 1985-1989.

A total of 528 patients have been treated with radical prostatectomy and node dissection during the last five years. Correlation of clinical and pathologic staging will be presented. Over 85 percent of these patients had Gleason scores of 6 or less. Patients who had nerve-sparing surgery had a potency rate of over 60 percent post surgery.

Oral calcium tolerance and urinary cyclic AMP in urolithiasis.

Oral calcium tolerance and urinary cyclic AMP testing was used in the evaluation of 61 unselected patients with stones. The oral calcium tolerance test was easy to perform and was useful in defining several distinct metabolic abnormalities contributing to calculous formation. Oral calcium tolerance testing is more precise than twenty-four-hour urinary calcium determination and should provide a means of determining proper medical treatment of urolithiasis. Urinary cyclic AMP was disappointing as a measure of parathormone activity.

Combined modality therapy for locally advanced penile squamous cell carcinoma.

We report here a patient who presented with locally advanced Jackson Stage IV penile squamous cell carcinoma who was managed with preoperative 5-fluorouracil, mitomycin C chemotherapy, and concurrent radiation therapy. He experienced an excellent partial response which allowed more limited surgery than would otherwise be indicated. He is still alive and well 5 years after completion of his treatment without side effects, local recurrence, or distant metastatic disease.

[A case of "midline granuloma" in a 29-year-old patient]. / Fall eines "Mittelliniengranuloms" bei einem 29jährigen Patienten.

The term "(lethal) midline granuloma" originates from the disease's clinical presentations, including various granulomatous, inflammatory and destructive changes as well as necrosis of the midface. The present paper discusses the case of a 29-year-old woman with a midline granuloma involving the left palatal cleft and affecting the nose and naso-maxillary sinus. In terms of the currently available literature the difficulties are shown in diagnosing "midline granuloma" from other possible diseases using histomorphological criteria. Various therapies are discussed, including those used in the present case.

Transrectal ultrasound used in office practice to aid in the diagnosis of carcinoma of the prostate.

Transrectal ultrasound and TRUS-guided needle biopsy was studied in office practice to detect prostate cancer in men with palpably irregular prostates or elevated tumor markers (PAP/PSA). Of 330 men examined, 118 had TRUS biopsy: 33 were positive for adenocarcinoma, 13 were small volume, low stage lesions treated by R.R.P. Twenty-eight percent of all patients biopsied had adenocarcinoma: 11% (13) had low volume, low stage disease potentially curable by radical surgery, representing 4% of the total studied. TRUS in combination with markers does aid in the diagnosis of low stage prostatic adenocarcinoma. It is a practical, useful, office-based urologic procedure.

Scrotal implantation of the inflatable penile prosthesis.

Erectile impotence has been a problem for the patient and a frustration for the physician since the beginning of medical history. The inflatable penile prosthesis rapidly is becoming the standard for treatment of organic erectile impotence. A technique is described for implantation through a single midline scrotal incision. Intra-abdominal reservoir placement is possible through this incision. The technique shortens operative time and hospital stay, and minimizes postoperative patient discomfort. Of the 31 patients who have been managed in this way the postoperative course for 18 is more than 12 months. The results as judged by patient and sexual partner have been excellent to date.